This proposal is for years 18 through 22 of the Seattle Longitudinal Prospective Study on Alcohol and Pregnancy, a population-based study begun in 1974 to examine the long-term consequences of varying levels and patterns of prenatal alcohol exposure. We predict that prenatal brain damage from alcohol causes neurobehavioral/attentional/cognitive disabilities in young children which make them vulnerable to school and behavior problems and the late adolescent emergence of psychopathology. A birth cohort of 500 offspring, selected from a population-based study of 1,500 women interviewed in mid-pregnancy in 1974/75, will be studied in late adolescence. Relevant covariates and child outcomes from eight previous waves of data collection will be examined longitudinally to determine the pathways of deficit. Four new data acquisition waves are proposed: an 18 Year Questionnaire Study; a High School Records Review; a 19 Year Lab Visit; and a 21 Year Phone Interview. Five hypotheses will address the discovery of direct and indirect pathways through which prenatal alcohol exposure impacts long-term attentional and cognitive deficits, mental and academic performance, psychopathology, alcohol and drug use and abuse, and "real life outcomes" such as school problems and performance. Three hypotheses will examine outcomes not previously studied here, but which can reflect the long-term consequences of prenatal alcohol exposure, namely dermatoglyphic asymmetry; hand form and facial change assessed morphometrically; hand form and facial change (assessed morphometrically); fluid intelligence (Gf); and frontal lobe/hippocampal function. Two hypotheses will address the identification of early school age children as probable Fetal Alcohol Effects (FAE) and the predictive accuracy of several definitions of FAE for developmental deficits in late adolescence. A second 5-year study is suggested to examine the direct and indirect pathways by which prenatal alcohol may give rise to psychiatric illness and adverse life circumstances in young adulthood. These proposed studies have far-reaching public health implications. Alcohol remains the teratogenic drug most frequently ingested during pregnancy. This proposal pursues into the late adolescent years the extension and consequences of the alcohol-related offspring effects found with this cohort at younger ages. This is the first study to systematically examine the direct and indirect pathways of association between prenatal alcohol and high school problems and behavior, psychopathology, and alcohol/drug abuse, as well as the first to examine in humans the possible relationships to frontal lobe and hippocampal